<div id="result">
<h2 class="search-title popSearchTitle">Feedback/Contact Us</h2>
<div class="ques-popup">
    <div style="font-size:14px;">Find out how we can help you reach your goals.</div>
    <br/>
    <form action="<?php echo Configure::read('base_url');?>user_agreements/feedback" method="post" id="message">
<fieldset>
    <label>Name<em>*</em> :</label>
<input type="text" value="" name="name" class="required" title="Required"/>
 </fieldset>
 <fieldset>
 <label>Address  :</label>
 <input type="text" value="" name="address" />
</fieldset>
<fieldset>
    <label>Email<em>*</em> :</label>
    <input type="text" value="" name="email" class="required email"  title="Required"/>
</fieldset>
<fieldset>
    <label>Phone Number:</label>
    <input type="text" value="" name="phone" />
</fieldset>
<fieldset style="padding:10px 0; border-top:1px solid; border-bottom:1px solid; margin:10px 0;">
<label style="display:block; float:none;">Message<em>*</em> :</label>
<textarea name="message" class="required"  title="Required"></textarea>
</fieldset>
<fieldset class="btn">  
  <input type="submit" value="Send" class="button" name="sendMessege" />
</fieldset>
</form>
</div>
</div>
<?php  echo $html->script(array("jquery.min.js","jquery.form.js","jquery.validate.js", "jquery.tablesorter.min.js", "jquery.tablednd.js")); ?>
<script type="text/javascript">
 jQuery(document).ready(function(){

// show a simple loading indicator
		var loader = jQuery('<div id="loader"><img src="<?php echo Configure::read('base_url');?>img/loading.gif" alt="loading..." /></div>')
			.css({position: "relative", top: "1em", left: "25em"})
			.appendTo("body")
			.hide();
		jQuery().ajaxStart(function() {
			loader.show();
		}).ajaxStop(function() {
			loader.hide();
		}).ajaxError(function(a, b, e) {
			throw e;
		});

		var v = jQuery("#message").validate({
                    rules: {
                    },
      submitHandler: function(form) {
				jQuery(form).ajaxSubmit({
					target: "#result"
				});
			}
		});
});
</script>